Managing Risk

The content of this Web page is adapted from chapter six of the
Fieldbook, item no. 33104. This essential reference for outdoor
activities may be purchased online at www.scoutstuff.org.

An injury that doesn't happen needs no treatment. An emergency that doesn't
occur requires no response. An illness that doesn't develop demands no remedy.
The best way to stay safe in the outdoors is to avoid getting into trouble in
the first place. That requires planning, training, leadership, good judgment,
and accepting responsibility—in short, risk management.

We manage risk in almost every aspect of our lives. There is risk involved
in stepping out of our homes in the morning, but we go anyway. There are risks
in crossing a street, catching a bus, and taking part in sports, but we find ways
to minimize these risks and maximize our safety and well-being.

Risk management is so much a part of outdoor adventures that often we hardly
notice we are doing it. When we fill bottles with water from streams and lakes,
we deal with the risk of parasites by treating the water with a filter or
chemicals, or by boiling it. When we share the outdoors with bears, we protect
them and ourselves by hanging our food out of their reach, eliminating odors
from our sleeping areas, and keeping campsites spotless. When foul weather
blows in, routes become uncomfortably exposed, streams swell, or snow loads
make avalanches a possibility, we consider all the available information and
then make decisions that keep risks at acceptable levels.

Perceived risk can energize outdoor activities by bringing to them an
immediacy that is sharper than what we normally experience. The actual risk on
a well-managed ropes course, for example, is relatively low, but participants
experiencing the events of the course might perceive that the risk is much
higher than it actually is. That heightened awareness can take them beyond
their usual comfort levels and encourage them to accept challenges that will
stretch their abilities and build their confidence.

The only way to eliminate risk completely in the out-of-doors is to give up
the pleasures, challenges, and satisfaction of taking part in an adventure.
Rather than attempting to do away with it, group members and leaders can manage
risk by identifying its sources, understanding its boundaries, and tailoring
their behavior to minimize exposure to danger.

Shared Management of Risks

Many outdoors-oriented organizations have guidelines to address certain
hazards they believe to be of particular concern to their members. This
chapter, for example, will discuss hypothermia, lightning, and several
other potential risks of great interest to the Boy Scouts of America. A
truly effective approach to risk management, though, is found not just in
the details, but also in the willingness of everyone in a group to take an
active role in maximizing his or her own safety and the safety of
others.

Risk Management

Here are three keys to effective risk management:

Everyone in the group commits to having a safe experience.

Everyone understands and follows group guidelines established to minimize risk.

Everyone has a say in recognizing and dealing with risks that arise during a trek.

A leader who empowers group members with resources, training, and
responsibilities for conducting successful treks often will find that they
also can be trusted to do their part to manage risk. When each person has
a part to play in the success of a trek, everyone has a stake in risk
management. Group members are far better prepared to deal with illnesses or
injuries if they are versed in response plans and if they know where they
are, what resources are at their disposal, and what skills they can draw
upon. On the other hand, leaders who expect group members simply to obey
rules and instructions—to be followers rather than thinkers and problem
solvers—might discover that their groups aren't able to deal effectively
with the changing nature of risk.

Stay in good shape so you are ready for the physical
demands of a trek.

Know where you are going and what to expect.

Adjust clothing layers to match changing conditions.

Drink plenty of water.

Protect yourself from exposure
to the sun, biting insects,
and poisonous plants.

Take care of your gear.

A critical aspect of risk management is letting others know when you are
having difficulties or are aware of a concern that might affect you or the
group. Many people have a tendency to keep things to themselves. They don't
want to slow down the group, or are worried about what others will think of
them. But stopping for a few moments to deal with a hot spot on a heel can
help avoid bringing the group to a long halt later in the day when blisters
break out. Voicing concern about changing weather or questionable route
decisions can bring important matters to the attention of the rest of your
group.

Outdoor-Oriented First Aid

Take care of yourself, and you will be far less likely to have trouble on the
trail. You also will be much better able to help others deal with difficult
situations.

We often go to remote areas to get away from it all, but among the things
we are getting away from is quick access to emergency support and care. If
someone has an accident in an American city, dial 911 and an emergency team
will probably be on the scene in minutes, ready to treat injuries and to
provide transport to a medical center.

The farther that group members are from medical facilities, the more
important is their ability to deal with emergencies on their own. Responding
to incidents during trek adventures can involve not only immediate treatment,
but also evacuating ill or injured persons to the frontcountry, or stabilizing
them and maintaining their safety for hours or even days until medical
assistance arrives.

Those who intend to travel in the backcountry should prepare themselves
with first-aid training, ideally including training in caring for injured
and ill persons in remote settings. Among the training courses available in
various parts of the country are Red Cross Wilderness First Aid Basic,
Wilderness First Responder, Wilderness Emergency Medical Technician, and
Mountaineering Oriented First Aid.

Preparing a Group to Manage Risk

Rescue team professionals and trained volunteers responding to backcountry calls
can be exposed to considerable risk. Never hesitate to summon help when you need
it, but minimize the need for assistance by preparing well and doing your best
to proceed in ways that maximize your safety and that of others.

Risks associated with the outdoors can involve rain, wind, heat, cold,
avalanche, water, wildlife, vegetation, and falling. Human elements
affecting risk include lack of physical preparation, improper training,
poor judgment, and unreasonable expectations by group members, leaders,
parents, and others. Many of these concerns can be addressed by leaders
helping group members decide upon activities that are appropriate to their
skills, experience level, and interests. Preparing a group to manage risk
also involves a certain amount of pretrip paperwork and development of an
emergency response plan.

For more on matching groups with appropriate activities, see the chapters
titled "Organizing for Adventures," "Outdoor Leadership," and "Planning a
Trek."

Paperwork

The policies of a given organization will determine the paperwork that
must be completed before a trek begins—releases for medical treatment,
for example, proof of health insurance, tour permits, and any forms required
by land management agencies. Leaders also should be fully informed in writing
if a group member requires medications, has any medical issues, or deals with
allergies. Always prepare a written itinerary of where you plan to be on each
day and night of a trek. Leave copies with several responsible people who will
take appropriate action if you haven't returned according to schedule.

Emergency Response Plan

Developing a written emergency response plan requires group members to
figure out the steps to be taken during trek emergencies and to write down
contact information for agency personnel, law enforcement authorities, and
medical response networks. The plan should outline strategies for contacting
help, if help is needed. Along with your group's roster, itinerary, intended
route, and expected time of return, give copies of the emergency response
plan to support persons in the frontcountry.

For more on itineraries and emergency response plans, see the chapter
titled "Planning a Trek."

Wireless Telephones and Risk Management

Global positioning system (GPS) receivers allow travelers to pinpoint
locations, but they are no substitute for mastering the use of maps and
compasses. Likewise, wireless telephones can be a convenient means for
groups to contact emergency response personnel, but phones are useless if
they malfunction, the batteries are exhausted, or distance and terrain
prevent clear reception of signals.

Frivolous use of wireless phones can seriously diminish solitude,
independence, and challenge in the outdoors. If you carry a portable
telephone, stow it deep in your pack and bring it out only for emergency
calls. Most of all, never assume that having a portable telephone grants
you any protection to attempt activities beyond your levels of skill and
experience, especially if you are far from emergency support.

Managing Risk in the Field

The degree of risk in a situation depends on a host of factors that can
change from one moment to the next. Take, for example, a log that, a
few feet above a stream, offers an inviting route for hikers to reach the
far bank. On a warm day in a BSA local council camp, the risk involved
in walking across the log might be very low. Even if you fall, it's not far
to the water. If you get wet, you can go to your tent and change clothes.
If you sprain your ankle, you are close to medical assistance. Do you walk
over the log? Probably.

During a backpacking trip, you come upon a similar log lying across a stream,
but this one is located miles up a trail and the day is windy and cold. If you
slip off the log, you have only the clothing you are carrying to replace wet
garments. If your pack is submerged, the clothes, food, and gear stowed in it
could become soaked. If you hurt your ankle, you might be stranded miles from
a road. Do you use the log to cross the stream? Perhaps, but you might decide
to lessen the risk by straddling the log and scooting across in a sitting
position, or you might wade if the stream is calm and shallow, or you might
seek out a better place to cross. Each option will take longer than walking
the log, but not nearly as long as dealing with the possible results of a
fall.

Managing risk often is a matter of considering the "what if" of a situation.
What if I fall? What if I lose my pack? What if I sprain my ankle? Other
considerations that might be factors are the time of day, your group's level
of fatigue, hunger, or anxiety, and the amount of experience you've had with
similar situations.

Put lots of faith in your gut feeling about a situation. If it doesn't seem
right but you're not sure why, your instincts might be telling you something
you need to know, but have not yet fully understood. Take plenty of time to
consider your options.

Anyone in a group should feel empowered to call a halt to group activities
whenever he or she perceives a risk that should be addressed. In turn, group
leaders and other members must respect those concerns and give them full
consideration.

While the tone of a group is best when it is upbeat and members strive to
see the positive in every situation, it's good to be a pessimist about hazards,
erring on the side of too much caution rather than not enough. The risk
management portion of your brain should be focused on what could go wrong so
that you can act in ways that increase the likelihood of things going
right.

Incident Response

Risk management is not built on a list of rules, but rather on good judgment
and a willingness to accept responsibility for one's own safety and that of
others. Incident response is what happens when an injury or illness has
occurred during a trek and a group must decide how to handle it.

Accounts of injuries and illnesses in the outdoors often try to pinpoint a
specific cause. Hypothermia, for example, often is blamed on chilly weather,
cotton clothing, and precipitation. Of course, the steps that led to poorly
dressed travelers shivering in the rain can be traced back to decisions that
might easily have prevented that dangerous situation from occurring at all.
With qualified leadership, personal responsibility, and effective planning,
those travelers would have had warm clothing and rain gear. They would have
been well-hydrated and have had energy food in their packs. They would have
kept an eye on the weather and made timely decisions about where to go, when
to camp, and whether to turn around and go home.

The following pages discuss ways to prepare for and manage certain risks,
and also the basics of how groups can respond to incidents brought about by
these concerns. (Watercraft adventures and some other trek activities present
specific risk management issues that will be addressed in the chapters
discussing those activities.)

Dehydration can play a significant role in a number of maladies including heat
exhaustion, heatstroke, hypothermia, and frostbite.

Dehydration

Water is essential for nearly every bodily function, including brain activity
and temperature control. We lose moisture through breathing, sweating,
digestion, and urination. A person who gives off more water than he or she takes
in risks becoming dehydrated. The first sign of dehydration usually is dark
urine. Other signs can include weariness, headache and body aches, and
confusion.

Help keep your body in balance by eating enough throughout the day. The
importance of drinking plenty of fluids cannot be overemphasized. Don't wait
until you feel thirsty—that's an indication that you are already becoming
a bit dehydrated. Replenish your water supplies at every opportunity and drink
often in warm weather and cold alike.

Incident Response for Dehydration

A person showing any indications of dehydration should rest in the shade
and sip water until the symptoms subside.

Heat Exhaustion

Heat exhaustion can be brought on by a combination of dehydration and a
warm environment. The condition is not uncommon during sports activities and
trek adventures conducted in hot weather, especially if participants are not
fully acclimated to the conditions. Symptoms can include the following:

Skin that is pale and clammy from heavy�sweating

Nausea and tiredness

Dizziness and fainting

Headache, muscle cramps, and weakness

Incident Response for Heat Exhaustion

To treat heat exhaustion, have the victim lie in a cool, shady place with
the feet raised. Remove excess clothing. Cool the victim by applying cool,
wet cloths to his or her body and by fanning. If the victim is fully alert,
let him or her sip from a glass of water and take bites of salted food, such
as nuts. Recovery should be rapid. If symptoms persist, call for medical
help.

Heatstroke

Heatstroke occurs when a person's core temperature rises to a life-threatening
level (above 105 degrees). Causal factors include dehydration and over exertion
in hot environments. Symptoms can include hot, red skin that can be either dry
or sweaty; confusion; and a rapid pulse.

Incident Response for Heatstroke

A heatstroke victim must be cooled immediately. He or she is in danger of
dying. To quickly lower the body temperature and begin restoring hydration,
move the victim to a cool, shady spot and cool him or her any way you can.
Keep the victim lying down and comfortable, with head and shoulders slightly
raised. Remove outer clothing and sponge the victim with cold water. Cover
the victim with wet towels, wet clothing, or whatever else is handy, and fan
him or her. Place the victim in a stream, in a tub filled with cool (not
ice-cold) water, or in front of an air conditioner running full blast in a
house or car. Use combinations of all available treatments.

Get emergency medical help as soon as possible. The victim's temperature
might go up again, or he or she might vomit or require rescue breathing.

For more on conducting trek adventures when temperatures are warm, see the
chapter titled "Hot-Weather Travel and Camping."

A group that knows how to treat hypothermia should be well enough aware of the
risk that its own members will seldom, if ever, need to be treated for it.

Hypothermia

Hypothermia occurs when a person's body is losing more heat than it can
generate. It is a danger for anyone who is not dressed warmly enough, though
simple exposure to cold is seldom the only cause. Dehydration is a common
factor. Wind, damp clothing, hunger, and exhaustion can further compound the
danger. The temperature doesn't have to be below freezing, either—a
lightly dressed hiker caught in a cool, windy rain shower can be at great
risk. So is a swimmer too far out in chilly water or immersed too long.

Treat a victim of hypothermia by preventing him or her from getting colder
and, if necessary, by using any or all of the following methods to help the
body warm again to its normal temperature.

If the person is fully conscious and can drink, offer plenty of warm
liquids (cocoa, soup, fruit juices, water).

Move the person into the shelter of a building or a tent and get him
or her into dry, warm clothes.

Zip the person into a dry sleeping bag. Cover the head with a warm hat
or sleeping bag hood.

Provide water bottles filled with warm fluid to hold in the armpit and
groin areas.

If hypothermia is advanced, help the person to breathe warm, moist air to
aid in rewarming.

Monitor closely and be ready to administer other first aid.

Seek medical care.

While one person is being treated for hypothermia, the rest of a group also
might be at risk. Protect yourself and others by taking shelter, putting on
layers of dry, warm clothing, and having something to eat and drink. Look
after one another.

Frostbite

Flesh exposed to low temperatures or cold wind can freeze. Far from the
warmth of the body's core, toes and fingers are especially vulnerable, as
are the nose, ears, and cheeks. A frostbite victim might complain that his
or her ears, nose, fingers, or feet feel painful and then numb, but some
victims won't notice anything. Grayish-white patches on the skin are signs
of frostbite. Since dehydration increases the danger of frostbite, cold-weather
travelers must be every bit as diligent about drinking fluids as they are
when the temperature is high.

Incident Response for Frostbite

Only superficial frostbite—frostnip—can be treated in the field.
If you suspect that frostbite is deep (extending below skin level), wrap the
injured area in a dry blanket and get the victim under the care of a physician
as soon as possible. Don't rub the injury.

To treat frostnip, move the victim into a tent or building, then warm the
injured area and keep it warm. If an ear or cheek is frozen, remove a glove
and warm the injury with the palm of your hand. Slip a frostnipped hand under
your clothing and tuck it beneath an armpit. Treat frostnipped toes by putting
the victim's bare feet against the warm skin of your belly.

For more on conducting trek adventures in chilly conditions, see the chapter
titled "Cold-Weather Travel and Camping."

Sunburn

Although skin appears to recover from sunburn, damage to its cellular
structure accumulates. That can lead to premature wrinkling and is a
primary cause of skin cancer. Use sunscreen to protect exposed skin, giving
special attention to your face, ears, nose, and neck. To be effective,
sunscreen should have a sun protection factor (SPF) of at least 15. Apply
it liberally before sunlight exposure, and reapply if you are sweating and
after immersion in water. Hats with large brims, long-sleeved shirts, and
long pants will provide further protection.

Sunlight reflected by water or snow can intensify the damaging effects
of solar radiation. Zinc oxide offers total blockage of the sun's rays, and
might be what you need for your face and ears during watercraft adventures
and treks at high altitudes or on snow. Wear sunglasses to prevent eyestrain,
and shield your lips against chapping and sun injury by applying a lip balm
with an SPF of 15 or higher.

Incident Response for Sunburn

Prevent further injury by getting out of the sun, either by seeking shade
or by putting on a hat and clothing that affords protection. Treat painful
sunburn with damp cloths. Remedies containing aloe vera also might provide
relief.

Lightning

Open water, mountaintops, the crests of ridges, the bases of tall or solitary
trees, and large meadows can be hazardous places during lightning storms. Plan
to be off peaks and other exposed locations before afternoon when thunderstorms
are more prevalent. If you are caught in a dangerous area, quickly move to shore
or descend to a lower elevation, ideally away from the direction of the
approaching storm. A dense forest located in a depression offers the greatest
protection. Stay clear of shallow caves and overhanging cliffs—ground
currents might arc across them. Avoid bodies of water and metal fences, too,
and anything else that might conduct electricity. In a tent, stay as far as
you can from metal tent poles.

If a lightning storm catches your group in the open, spread out so that
people are at least 30 feet from one another. Further minimize your risk by
crouching low with only the soles of your shoes touching the ground. You can
use your sleeping pad for insulation by folding it and crouching upon
it.

Incident Response for Lightning Strikes

Persons struck by lightning might suffer varying degrees of burns. Of more
immediate concern is the likelihood that their hearts have stopped beating and
they are no longer breathing. Treat by checking their circulation and
respiration; if necessary, perform CPR (cardiopulmonary resuscitation). Once
they are stabilized, attend to burns or other injuries, treat for shock,
and closely monitor their vital signs until they are under a physician's
care.

For more on lightning and its causes, see the chapter titled "Monitoring
Weather."

Flash Floods

In arid regions of the country, dry streambeds and small creeks can become
raging rivers in just a few minutes. The rains causing the flood might be
falling right where you are, or they could be coming down miles upstream of
your location. When traveling in areas where flash floods are possible, make
it a point to always know how to reach the safety of higher ground. Pitch your
tents above the high-water marks of past floods. In flowing streams, watch
for an increase in the speed or volume of current and for other indicators of
imminent flooding. Moving water can be extremely powerful; stay clear of areas
that have become flooded.

Incident Response for Flash Floods

If you are caught in a flood, assume a position with your feet aimed
downstream, then use them to absorb impact against objects. Should you manage
to get to an island or into the branches of a tree, stay calm and wait for
assistance.

For more on surviving a fall into moving water, see the chapter titled
"Watercraft Adventure Safety." For more on safely crossing streams, see the
chapter titled "Mountain Travel."

Falling rocks pose a danger to unwary backcountry travelers. Loose stones at
the base of a cliff might indicate a likelihood of rockfall. If you hear a rock
clattering down, or if you accidentally kick one loose, shout "Rock!" to warn
those below to take cover.

Travel in areas with significant risk of avalanche is beyond the scope of
this book and calls for more specialized training.

As with any trek adventure risks, don't be reluctant to change your plans or
postpone a trip when avalanche danger is high. The mountains will still be there
for you after conditions have improved.

Avalanches

Avalanches are a serious concern for all travelers whose outings take them
into snowy, mountainous regions. An avalanche occurs when snow breaks loose on
a slope, or when a cornice of snow collapses and tumbles down. Large avalanches
can carry away trees and tents, and even a small snowslide can bury a person
caught in its path.

Your greatest protection against avalanches is knowing where, how, and when
they are likely to happen and then planning routes that take you elsewhere.
Indicators of danger include the following:

Signs of previous avalanches—conditions that were right
for past avalanches might well come together again to cause
future snowslides.

Steep terrain—avalanches usually happen on slopes of 40
to 60 degrees.

Accumulations of new snow—it takes a while for fresh
snowfall to consolidate enough to stabilize.

Variations in the quality of snow layers, especially if one
or more layers are airy, granular, or in slabs—a weak
layer in the snowpack can allow layers above to break loose
and slide.

Air temperature rising to near or above freezing, causing
changes in snowpack stability.

Sounds that suggest cracking or settling of the snowpack.

In addition to understanding the basics of avoiding avalanche zones, the
following steps will help you prepare for travel in steep, snowy
terrain:

Check local avalanche-forecasting networks (operated by
weather bureaus and land management agencies) before
setting out. The most useful networks are updated at
least once a day.

Choose travel companions who understand the danger of
avalanches and will do their part to manage the risk.

Carry avalanche safety equipment and know how to use it.
Battery-powered beacons worn by each group member emit a
radio signal that can be picked up by the beacons of
others.

Incident Response for Avalanches

If, despite your preparations and judgment, you see an avalanche roaring
toward you and you can't get out of its path, jettison your pack. Get rid of
skis, too, if you are wearing them. When the snow hits, move your arms and
legs in a swimming motion to keep yourself upright, and try to keep your head
above the surface. As the avalanche slows and begins to settle, push away any
accumulation of snow from your face to form an air pocket that will allow you
to breathe.

Should others in your party be caught in an avalanche, keep your eye on them
as long as you can, and note the exact place you saw them last. Hopefully,
they'll be wearing avalanche beacons so that you can recover them quickly. If
not, listen for their voices, probe the area with ski poles from which you've
removed the baskets, and don't give up hope. Sturdy short-handled shovels made
of plastic or metal can prove invaluable for freeing avalanche victims. People
have survived under the snow for 30 minutes before being rescued. Treat
avalanche victims for shock and hypothermia. For more on snow shovels, see
the chapter titled "Cold-Weather Travel and Camping."

Poisonous Plants

Vegetation greatly enriches outdoor experiences, but there are a few species
of plants that outdoor travelers will want to avoid. Poison ivy, poison oak,
poison sumac, and nettles can cause skin inflammation and itching. Don't eat
wild plants, including mushrooms, unless you are positive that you can identify
them and know that they are safe for human consumption. For more on vegetation,
see the chapter titled "Plants."

Incident Response for Exposure to Poisonous Plants

The irritants in poison ivy, poison oak, and poison sumac can take up to 10
minutes to bond with the skin. Thoroughly washing with soap and water, or with
water alone, soon after exposure to these plants can minimize their effects.
The same is true of nettles. Hydrocortisone cream might reduce itching. Avoid
scratching affected skin, as that can increase the size of the irritated
area.

If someone has ingested poisonous plants, induce vomiting. Save some of the
vomit in a plastic bag for medical analysis, and get the person to a
physician.

Anaphylactic Shock

In rare cases, stings or bites of insects can cause anaphylactic shock,
a condition that restricts breathing passages and requires immediate treatment
by a physician or a person trained in emergency first aid. People who are
allergic to peanuts, shellfish, and certain other foods can have similar
reactions if they ingest those items.

Travelers who know they are susceptible to anaphylactic reactions (and
anyone dealing with asthma) should consult with their physicians to prepare
themselves for the outdoors with strategies and treatment kits, and should
share that information with the leaders of their groups.
For example, the
emergency kits
carried by people who know they might suffer from anaphylactic
shock often include an EpiPen®
for injecting a measured dose of
epinephrine.

Asthma

The symptoms of an asthma attack can be similar to those of a person
suffering anaphylactic shock—a constriction of the throat and increasing
difficulty in breathing. Conditions that might trigger an asthma attack include
dust, physical exertion, changes in humidity, and changes in elevation. Many
people coping with asthma use inhalers and other forms of medication to treat
asthma episodes. Before a trek begins, they should fully inform group leaders
of their health histories, treatment regimens, medications, and the locations
of those medications.

Animals

Seeing animals in their natural habitat is always a pleasure, but it's wise
to remember that they are the permanent residents of the backcountry while we
humans are the visitors. Treat animals with respect, give them enough space so
they won't feel threatened by your presence, and properly manage your food
storage, and they seldom will present a risk to your safety.

When it comes to insects, accept the fact that there are lots more of them
than there are of us, and that some will be delighted to take a bite out of
you. Reduce the likelihood of that happening by applying repellents or by
wearing long pants, long-sleeved shirts, and head nets.

For more on wildlife, see the "Leaving No Trace" section of this book, and
the chapters titled "Observing Nature" and "Wildlife." For more on insect
repellents, see the chapter titled "Hot-Weather Travel and Camping."

Incident Response for Animal-Caused Injuries

In the event that you are scratched or bitten by an animal, seek medical
attention; a physician must determine whether antibiotic, rabies, or other
treatment will be necessary.

Bears

For guidelines on managing risk in bear country, see the chapter titled
"Traveling and Camping in Special Environments."

Bee and Wasp Stings

Scrape away a bee stinger with the edge of a knife blade, but don't
squeeze the sac attached to the stinger—that might force more venom
into the skin. An ice pack or cool compress might reduce pain and swelling.
Watch for any indications of anaphylactic shock.

Tick Bites

Ticks are small bloodsucking arthropods that bury their heads in the flesh
of their hosts. Protect yourself whenever you are in tick-infested woodlands
and fields by wearing long pants and a long-sleeved shirt with snug cuffs and
collar. Button your collar and tuck the cuffs of your pants into your boots
or socks. Inspect yourself and other group members daily, especially the hairy
parts of the body, and immediately remove any ticks you find.

If a tick has attached itself, grasp it with tweezers close to the skin and
gently pull until it comes loose. Don't squeeze, twist, or jerk the tick, as
that might leave its mouthparts in the skin. Wash the wound with soap and
water, and apply antibiotic ointment. After dealing with a tick, thoroughly
wash your hands. If a tick has been embedded more than a day or poses
difficulties in removal, see a physician.

Lyme disease is an illness carried by some ticks. A red ringlike rash might
appear around the bite. A victim might feel lethargic and have flulike symptoms,
fever, a sore throat, and muscle aches. Anyone experiencing these symptoms in
the days and weeks following a trek adventure, especially activities in areas
where ticks are known to carry Lyme disease, should be checked by a
physician.

Chigger Bites

Almost invisible, chiggers burrow into skin pores where they cause small
welts and itching. Try not to scratch chigger bites. You might find some
relief by covering chigger bites with hydrocortisone cream or by dabbing them
with clear fingernail polish.

Spider Bites

The bite of a female black widow spider can cause redness and sharp pain at
the wound site. The victim might suffer sweating, nausea and vomiting, stomach
pain and cramps, severe muscle pain and spasms, and shock; breathing might
become difficult.

The bite of a brown recluse spider might not hurt right away, but within
two to eight hours there can be pain, redness, and swelling at the wound. An
open sore is likely to develop. The victim might suffer fever, chills, nausea,
vomiting, joint pain, and a faint rash.

Victims of spider bites should be seen by a physician as soon as
possible.

Scorpion Stings

Scorpions might startle you if you find them underneath your tent or ground
cloth, or shake them out of your boots first thing in the morning. They usually
are more imposing than they are dangerous, and scorpions that can cause humans
serious injury are uncommon. Ordinary scorpion stings usually are not as
dangerous as bee stings; they can cause severe, sharp pain, swelling, and
discoloration, but generally have no lasting ill effects. If you are stung,
cool the wound area with cold water or ice and seek medical attention.

Snakebites

Snakes are found in many parts of the country, but bites from them are rare.
Snakes try to avoid humans, usually striking only when cornered or surprised.
Use a hiking stick to poke among stones and brush ahead of you when you walk
through areas where snakes are common. Watch where you put your hands as you
collect firewood or climb over rocks and logs. Snakebites seldom result in
death.

The bite of a nonpoisonous snake causes only minor puncture wounds and
requires only ordinary first aid for small wounds—scrubbing with soap
and water, then treating with an antiseptic.

A poisonous snakebite might cause the victim to feel sharp, burning pain.
The area around the bite might swell and become discolored. However, a
poisonous snake does not inject venom every time it bites. Know which
poisonous snakes are native to the area you plan to hike, and know how to
identify them.

Snakes are not warm-blooded and so cannot carry rabies, though any bite
that breaks the skin has the potential of causing infection.

Incident Response for Poisonous Snakebite

Get the victim under medical care as soon as possible so that physicians can
neutralize the venom. A person who has been bitten by a poisonous snake might
not be affected by the venom for an hour or more. Within that time, the closer
to medical attention you can get the victim, the better off he or she will be.
The victim might be able to walk; carrying him or her also might be an option.
Before setting out, do the following:

Encourage a frightened victim to remain calm, and give reassurance
that he or she is being cared for.

Remove rings and other jewelry that might cause problems if the
area around a bite swells.

If available within three minutes of the bite, apply a Sawyer
Extractor® directly over the fang marks and leave in place
for no more than 10 minutes. Properly used, the extractor can
remove
up to 30 percent of the venom. Do not make any cuts on
the bite—
that's an old-fashioned remedy that can cause
the victim much more harm than help.

Immobilize a bitten arm with a splint and a sling, keeping the
wound lower than the level of the victim's heart.

Do not apply ice to a snakebite. Ice will not help the
injury, but could cause damage to skin and tissue.

If the victim must wait for medical attention to arrive, add these treatment
steps:

Have the victim lie down and remain still. Position the bitten
part lower than the rest of the body. If you have not done so
already, immobilize the bitten limb with a splint.

Put a broad constricting band (a bandanna or a strip of cloth
at least 1 inch wide) around the bitten limb 2 to 4 inches above
the bite (between the heart and the bite) to slow the spread of
venom. This is not a tourniquet; it is intended to impede the
lymphatic system but not the circulation of blood. The band
should be snug, but loose enough to slip a finger under easily.
Periodically check for a pulse
on both sides of the band.
You must not cut off blood circulation entirely. Do not use a
constriction band around a finger, a toe, the head, or the
trunk.

Treat for shock, but keep a bitten extremity lower than the
heart.

When helping victims of bites or stings, do whatever you must to avoid being
bitten or stung yourself. A rescuer who becomes injured could greatly
complicate any emergency situation.

Shark Attacks

Though rare, shark attacks on humans create dramatic headlines in the media.
Many more people die each year from the effects of bee stings than from shark
bites. Reduce even that remote likelihood of a shark attack by avoiding areas
where sharks are known to congregate. Don't enter the water alone. Blood, fish
bait, and human waste in the water might attract sharks, as can bright objects
such as jewelry. If sharks are sighted, return to shore quickly but with a
minimum of splashing.

Jellyfish Stings

Your trips along shorelines and on the open sea can bring you within
proximity of a variety of animals you will enjoy observing from a distance.
The Portuguese man-of-war and jellyfish have stinging cells on their
tentacles. When touched, the toxins in those cells may attach to the skin
and cause a sharp, burning pain.

Do not wash affected skin with fresh water, as that can cause the release
of more toxin. Instead, soak the injury for 30 minutes in alcohol or vinegar,
then use tweezers to remove the remaining tentacles. Quickly get the victim
under medical care. People who are allergic to jellyfish stings might go into
deep shock.

Keeping Risk in Perspective

Perhaps the greatest risk to be managed during trek adventures is also one
of its real attractions—the simple matter of distance. The farther you
travel from clinics, physicians, and rescue squads, the more you must rely
upon yourself and your companions to maintain your safety. Of course, the
best response to risk is to stay out of trouble in the first place. That
requires planning, leadership, and an awareness of your surroundings so that
you can make good decisions every step of the way. Add the first-aid training
you need to respond effectively to an illness or injury that might arise, and
you can make the management of risk second nature on every outdoor
adventure.